ENDOTHELIAL PROGENITOR CELLS IN PATIENTS WITH LUNG CANCER: THE EFFECT OF SYSTEMIC INFLAMMATION AND SURGICAL TUMOR RESECTION

ENDOTHELIAL PROGENITOR CELLS IN PATIENTS WITH LUNG CANCER: THE EFFECT OF SYSTEMIC INFLAMMATION AND SURGICAL TUMOR RESECTION. Objective Endothelial progenitor cells (EPCs) are believed to play a role in vascular repair and might promote abnormal vascularisation in neoplastic sites. The clinical implications of EPCs in patients undergoing surgical treatment for NSCLC is lacking. Aim of the study was to compare in the time course of two group of patients undergoing thoracic surgery, the number of EPCs circulating and the influence of C-reactive protein (CRP) levels, a marker of systemic inflammation on such expression. Methods The number of circulating EPCs and CRP concentration were measured by FACS analysis and nephelometry, respectively, in 30 patients with lung cancer undergoing lobectomy and in 12 patients undergoing pulmonary resection for benign diseases (Controls). Measurement of EPCs was repeated 48 hours after thoracic surgery and at the patients’ discharge. Results Patients with lung cancer had lower median (25th-75th percentile) EPC levels than Controls 183/mL (103-334/mL) vs 278/mL (109-467/mL), p<0.05. Higher plasma CRP levels were in patients with cancer than in Controls (0.53±0.15 mg/dL vs 0.35±0.12 mg/dL, p<0.05). CRP levels were negatively associated with the number of circulating EPCs in patients with lung cancer but not in Controls. Forty-eight hours after surgical resection, the number of EPCs decreased in both groups of patients, the EPC number being lower in patients with lung cancer. At hospital discharge the number of EPCs rose both in patients with lung cancer and Controls, reaching higher levels than those measured at baseline. Conclusions Patients with lung cancer have a reduced number of circulating EPCs, possibly as a consequence of the over-activation of the inflammation cascade sustained by lung cancer. Surgical resection leads to a transient decrease, followed by a later increase in the number of circulating EPCs. Further studies are required to demonstrate if the EPC increase post-surgery has a detrimental effect on the prognosis of the patients.